Meckel腔影像学检查方法比较

时间:2017-08-11 论文范文 我要投稿

                               作者:高传平,徐文坚,郝大鹏,冯卫华,刘吉华

 

【关键词】  Meckel腔;体层摄影术,X线计算机;磁共振成像

  [摘要]目的 探讨正常Meckel腔(MC)CT和MRI最佳检查方法及序列。方法 60例MC正常成人分为3组:20例行SE T1 WI、GRE T1 WI及FSE T2 WI扫描,20例行SE T1 WI-C+ 、FR FSE T2 WI及3D FSE T2 WI扫描,另20例行CT和CT-C+ 扫描。采用双盲法评价并比较8种检查方法-序列对MC正常解剖结构的显示能力和伪影程度。结果 硬膜壁:显示外侧壁GRE T1 WI、3D FSE T2 WI和CT平扫不如其他5种方法( H=135.54, P < 0.05);显示内侧壁、上壁、前壁、下壁和后壁SE T1 WI、FSE T2 WI、FR FSE T2 WI和SE T1 WI-C+ 优于其他4种方法( H=122.76~142.22,P <0.05)。显示三叉神经节:SE T1 WI、FSE T2 WI、FR FSE T2 WI和SE T1 WI-C+ 优于其他4种方法( H=135.64,P <0.05)。显示三叉神经节周围静脉丛:SE T1 WI-C+ 优于其他7种方法( H= 139.54 ,P <0.05)。显示神经纤维:FSE T2 WI和FR FSE T2 WI优于其他6种方法( H=159.00,P <0.05)。显示三叉神经池:SE T1 WI、FSE T2 WI、FR FSE T2 WI和SE T1 WI-C+ 优于其他4种方法( H=147.00,P <0.05)。磁敏感伪影:GRE T1 WI和3D FSE T2 WI多于其他序列( H=150.84,P <0.05)。骨伪影:CT有伪影。牙齿和运动伪影:CT和MRI各序列无差别。结论 MC检查应首选SE T1 WI和FSE T2 WI;必要时可使用FR FSE T2 WI和SE T1 WI-C+ 作为补充;CT和CT-C+ 也可用于检查MC;GRE T1 WI和3D FSE T2 WI不适合MC检查。

  [关键词] Meckel腔;体层摄影术,X线计算机;磁共振成像

  
  [ABSTRACT]ObjectiveTo study the optimized method and sequence of CT and MRI on detecting the normal Meckel cave (MC). MethodsSixty people with normal MC were equally divided into three groups: Group Ⅰ, SE T1 WI, GRE T1 WI, and FSE T2 WI were performed; group Ⅱ, SE T1 WI-C+ , FR FSE T2 WI, and 3D FSE T2 WI were performed; and group Ⅲ CT and CT-C+were performed. The efficacy of the different methods mentioned above were compared in terms of the detection of the anat-omy of MC and the artifacts produced. Results Dural walls: GRE T1 WI, 3D FSE T2 WI, and CT were inferior to other five methods in the detection of lateral wall ( H=135.54, P< 0.05);SE T1 WI, FSE T2 WI, FR FSE T2 WI, and SE T1 WI-C+were su-perior to other methods in the detection of inner wall,superior wall, anterior wall, inferior wall, and posterior wall ( H=122.76-142.22, P <0.05). SE T1 WI, FSE T2 WI, FR FSE T2 WI, and SE T1 WI-C+were superior to other methods in detection of tri-geminal ganglion ( H=135.64,P <0.05). SE T1 WI-C+was superior to other methods in detection of perineural venous plexus of trigeminal ganglion ( H=139.54,P <0.05). FSE T2 WI and FR FSE T2 WI were superior to the other six methods in detection of nerve fibers ( H=159.00,P< 0.05). SE T1 WI, FSE T2 WI, FR FSE T2 WI, and SE T1 WI-C+were superior to the other four methods in detection of trigeminal cistern (H=147.00,P <0.05). Magnetic susceptibility artifact in GRE T1 WI and 3D FSE T2 WI were more than that of the other methods ( H=150.84,P <0.05). There was bone artifact on CT examination. There were no difference between tooth artifact and moving artifact on CT and MRI examination. ConclusionSE T1 WI and FSE T2 WI are the optimal methods for detection of MC;FR FSE T2 WI and SE T1 WI-C+can be used as supplement when necessary;CT and CT-C+an also be used, while GRE T1 WI and 3D FSE T2 WI are not appropriated.

  [KEY WORDS]Meckel cave; tomography, X-ray computed; magnetic resonance imaging

  本文通过对比正常Meckel 腔 (MC)的CT及MRI检查序列,探讨适合此区的影像学检查方法。

  1 资料与方法

  1.1 一般资料 选取60例因怀疑垂体、眼眶或鼻窦病变行CT或MRI检查无MC及周围病变者为研究对象,男32例,女28例,年龄18~65岁,平均45.9岁。

  1.2 检查方法 检查采用GE Signa 1.5 T超导MR机和Light Speed 16螺旋CT机。将60例病人分为3组,每组20例。第1组病人行自旋回波T1 加权成像(SE T1 WI)、梯度回波T1 WI(GRE T1 WI)和快速自旋回波T2 WI(FSE T2 WI);第2组行SE T1 WI增强扫描(SE T1 WI-C+ )、快速恢复FSE T2 WI(FR FSE T2 WI)和三维 FSE T2 WI (3D FSE T2 WI)。各种扫描参数见表1。增强扫描对比剂采用GD-DTPA 0.1 mmol/kg ,手推静脉注射完毕后,即开始扫描。第3组行CT平扫及增强扫描(简称CT-C+ )。层厚1.25 mm,层间间隔6.31 mm,螺距0.625∶1,矩阵512×512,电压120 kV,电流160 mA。对比剂:碘普罗胺300(90 mL),以3.0 mL/s高压注射器注射,注射完毕后开始扫描。横轴位扫描平行于蝶平面,扫描范围自垂体中部至中颅窝底;冠状位扫描垂直于蝶平面,扫描范围自垂体窝中部至斜坡前部。

  1.3 资料分析 ①MC结构评价:对MC硬膜壁、三叉神经节及其周围静脉丛、神经纤维和三叉神经池采用Ⅰ~Ⅲ级评分法,Ⅰ级:结构不显示,计分1分;Ⅱ级:结构显示不清,计分3分;Ⅲ级:结构显示清晰,计分5分。双侧取平均值。②MC伪影评价:对磁敏感伪影、邻近骨伪影、牙齿伪影和运动伪影亦采用Ⅰ~Ⅲ级评分法,Ⅰ级:伪影遮盖解剖结构,计为1分;Ⅱ级:有伪影,但能分辨解剖结构,计为3分;Ⅲ级:无伪影,解剖结构清晰,计为5分。双侧取平均值。统计处理采用秩和检验。

  2 结果

  2.1 MC硬膜壁 ①外侧壁:GRE T1 WI、3D FSE T2 WI和CT平扫显示较差( H=135.54,P <0.05),其他5种方法显示较好;②内侧壁:GRE T1 WI、3D FSE T2 WI和 CT平扫、增强扫描显示较差( H= 124.52 ,P <0.05 ),其他4种方法则显示较好;③上壁和前壁:GRE T1 WI、3D FSE T2 WI和CT平扫、增强扫描显示较差( H=124.77、129.92,P <0.05),其他4种方法则显示较好;④下壁:GRE T1 WI、3D FSE T2 WI和CT平扫、增强扫描显示较差( H=142.22,P < 0.05 ),其他4种方法显示较好。⑤后壁:GRE T1 WI、3D FSE T2 WI和CT平扫、增强扫描显示较差( H=122.76,P <0.05),其中前者不能显示,其他4种方法显示较好。见表2。

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